FLUID REPLACEMENT BEFORE, DURING AND AFTER EXERCISE

Introduction:
Water is the primary constituent by weight and volume of the human body. An 80-kg man contains about 53 L of water comprising 66 % of the body weight.

Introduction - Fluid balance

High rate of metabolic must be balanced by an equal heat loss to maintain core temperature. In warm weather, the only avenue of heat lost is by evaporation of sweat from skin.

Heat Illnesses
Represent a continuum of disorders that may range from the somewhat irritating to perhaps one of the most dramatic of medical emergencies, ranging intensity and severity from mild CV and central NS disturbances, such as hypotension and fainting, to profound cellular damage, such as the characteristic brain, kidney, liver, and blood clotting abnormalities of heatstroke.

Heat illness throughout history

1967 During Egypt-Israel Six Day War, an estimated 20,000 Egyptian lost their lives due to heat stroke . 1991 Desert Storm, US troops proven strategies that adopted from Israel.
Dryfuss (1991), Phys Sports Med

2003 3 Fatal report among our school children throughout their schools sport activities

Heat Illness
Third leading cause of death in young athletes
Farrel (1980), West J Med

Athletes gain heat from the environment as well as from muscle work. Participation in sports during hot, humid weather makes them particularly susceptible to heat illness. Children and adolescents are most susceptible to heat illness because they have a greater ratio of surface area to the body mass.

How Body Produce Heat

BMR alone could increase body temp. 1.1C/hour without any mechanism of dissipate. Hard work can increase body temp. 5C/hour and strenous exercise through sports may increase by 10 20 fold Robertshaw (1983) Studies in runners have shown that dehydration alone elevatebody and core temp up to 40C. For increase of 1C of core temp.will increase 13% of cellular metabolism

Heat Dissipation
Through 4 mechanisms: Radiation , convection, conduction and evaporation. When the ambient temp. exceeds body temp. however, evaporation of sweats is the dominat mechanism for heat loss, up to 95% of body cooling. Each 1.7 ml of sweat evaporated, the body loses 1 kcal of heat. The lost of body water through sweat will lead to dehydration

Adverse effects of dehydration

0 -

Percent of Body Weight Loss

Thirst threshold, and threshold for impaired exercise thermoregulation leading to decrement in physical and cognitive work capacity Stronger thirst, vague discomfort and sense of oppression, loss of appetite.

Dry mouth, increasing hemoconcentration, reduction in urinary output.

Decrement of 20-30 % in physical work capacity. Difficulty in concentrating,headache,impatience, sleepiness. Severe impairment in exercise temperature regulation, increased respiratory rate Leading to tingling and numbness of extremities Likely collapse if combine with heat and exercise ( Greenleaf et al., 1986)

The state of daily body water

Hyperhydration Euhydration

Hypohydration

Body water,% body mass

60% 53% 50% 40% 30% 30% 23% 20% 10% 0% Total Celullar ExtraCelullar Interstitial Plasma 19%

4%

Extracellular water Plasma water Interstitial water Cellular water Total water

= 23 L ( 29 % body = 4 L ( 5 % body = 19 L ( 24 % body = 30 L ( 37 % body = 53 L ( 66 % body

wt.) wt.) wt.) wt.) wt.)

Daily euhydration variability of total body water : Temperate conditions = 0.165 L ( 0.22% body wt.) Heat and exercise conditions = 0.382 L ( 0.48% body wt.)

Daily plasma volume variability = 0.027 L ( 0.6 % blood volume) Figure 1- Body hydration terminology diagram, and fluid compartment volumes and variability. ( Greenleaf,J.E.et al., 1986. Nutrition and Aerobic Exercise,p.107-124r)

Body Fluid State

Prior dehydration will impair the capacity to perform high intensity exercise as well as endurance activities and cognitive. Prolonged exercise, which resulted in a loss to fluid corresponding to 2.5% of body weight, resulted in a 45% fall in the capacity to perform HIE
Nielsen et al (1982); Armstrong et al (1985)

During sustained exercise in heat, 1 - 2 L/h of water may be lost as a result of sweating. Sawka
and Pandolf (1990)

Body Fluid State

World Cup 2002 Denmark players lost up to 4 L after 90-minutes of game. Light exercise will lost 1 L for 1 hour perform and become to 3L if intensity is increase. Research showed Athlete still in dehydrated instead of drinking during exercise.

Insensible 0.35L/d

Sweat 0.5 12 L/d

Respiratory loss 0.25 0.35 L/d

Feces 0.1 0.2 L/d

Urine 1 1.5 L/d

Routes of fluid loss from the human body. Range of values from McArdle, Katch & Katch (1986)

At dehydrated state:

Thermoregulation impaired: Increased heart rate followed by high utilized glycogen spared. Impaired performance due to heart rate and deplete glycogen induced exercise. Increased body core temperature to induced premature fatigue. (Maughan, 1999.)

Effects of fluids on performance

Type of drinks Time to exhaustion (min) No drink Plain water Glucose Fructose 70.2 86.2 89.2 65.6

maltodextrose 90.8
Exercise at 70% of VO2max
Source: Maughan et al., 2000

Hydration Strategies
Optimising fluid replacement Fate of ingested fluid depends on: - gastric emptying the rate gastric emptying of liquids is influence by : volume, energy density, osmolality and stress - intestinal absorbtion

Before Exercise
Body should be maintained at euhydrated state:
CHECK URINE COLOUR

Drink water prior to exercise. Within 2 hours before COMPETITION drinks 500 ml. (ACSM, 1996)

Everybody should be encouraged to monitor urine colour. Darker colours indicate an inadequate fluid intake.
Source: Urinary indices of hydration status (1994). Int J Sport Nutrition.

During exercise:
Drink water 600 1200 ml per hour If exercise finished less than hour, plain water are sufficient. If exercise longer than hour, electrolyte, CHO beverage should be concerned. Practice : 3ml per kg body weight per hour for every 15 20 minutes. (ACSM, 1996)

Fluid replacement after exercise.

The most important part for performance concern Minimum 150% of losing during exercise should be replaced. Water are not suitable Concern for electrolyte drink that contains: CHO, Na, K for replacement.

Effects of electrolytes on PV
4 2 0 -2
Plasma Volume (%)

-4 -6 -8
Drink Drink

PW SD CW SCW

-10 -12 -14 Euh State Exercise Rest

Rehydration Period 0 30 60 90 120

Time (min)

Ishak et al., (2002)

Drink

Fluid ingestion during recovery

Characteristic of the rehydration fluid may impact the volume of fluid consumed. (Hoswill,1998)
1. Palatability includes flavor, taste, mouth feel and temperature will influence the fluid consumed. The greater the volume consume, the less chance that dehydration will develop.

2.

Absorption How quickly a fluid empties from the stomach that depend on concentration and type of CHO, sodium presence and osmolality of the fluid.

Fluid ingestion during recovery

3. Electrolyte content The presence of electrolytes in a fluid can impact voluntary intake. The most critical electrolyte concern is sodium.
4. Ergogenic benefit While having ergogenic benefit does not directly stimulate drinking, the knowledge that a beverage can enhance performance may promote the athlete to consume a particular fluid.

Characteristic of the drinks

Sedap Suhu antara 4 - 15C kerana cepat pengosongan perut dan membantu dalam pelepasan oksigen. Kandungan gula tidak melebihi 6% Mengandungi electrolyte

Ingat!
Jangan berlengah mengambil minuman atau makanan sebaik sahaja selesai menjalani latihan. Elakan minuman yang mengandungi caffein dan alkohol

There is no single formulation

Conclusion
Fluid maintained throughout exercise: Increased resting plasma volume and maintained . Can maintained sweat rate as mechanism for thermoregulation. (1C increased in core temperature followed by increased HR for 30 bps respectively. Better maintenance of body temperature is achieved at the expense of increased sweat loss.